Table of Contents
OTHER WORKS BY IRVIN D. YALOM
Title Page
Dedication
Acknowledgments
PROLOGUE
Chapter 1 - Love’s Executioner
Chapter 2 - “If Rape Were Legal . . .”
Chapter 3 - “The Wrong One Died”
Chapter 4 - Fat Lady
Chapter 5 - “I Never Thought It Would Happen to Me”
Chapter 6 - “Do Not Go Gentle”
Chapter 7 - Two Smiles
Chapter 8 - Three Unopened Letters
Chapter 9 - Therapeutic Monogamy
Chapter 10 - In Search of the Dreamer
AFTERWORD
Copyright Page
OTHER WORKS BY IRVIN D. YALOM
The Theory and Practice of Group Psychotherapy
(Fifth Edition)
Existential Psychotherapy
Every Day Gets a Little Closer:
A Twice-Told Therapy (with Ginny Elkin)
Encounter Groups: First Facts
(with Morton A. Lieberman and Matthew B. Miles)
Inpatient Group Psychotherapy:
The Theory and Practice of Group Psychotherapy
(Fifth Edition)
When Nietzsche Wept
Lying on the Couch
The Yalom Reader
(edited by Ben Yalom)
Momma and the Meaning of Life
The Schopenhauer Cure
The Gift of Therapy
Staring at the Sun
I’m Calling the Police (with Robert Berger)
The Spinoza Problem
To my family:
my wife, Marilyn,
and my children, Eve, Reid, Victor, and Ben
ACKNOWLEDGMENTS
Most of this book was written during a well-traveled sabbatical year. I am grateful to many individuals and institutions who hosted me and facilitated my writing: the Stanford University Humanities Center, the Rockefeller Foundation Bellagio Study Center, Drs. Mikiko and Tsunehito Hasegawa in Tokyo and Hawaii, the Caffé Malvina in San Francisco, the Bennington College Creative Writing Program.
I am grateful to my wife, Marilyn (always my toughest critic and staunchest support); to my Basic Books editor, Phoebe Hoss, an enabling editor in this as in my previous books at Basic; and to my project editor at Basic Books, Linda Carbone. Thanks also to many, many colleagues and friends who did not bolt when they saw me approaching, a new story in hand, and offered criticism, encouragement, or consolation. The process has been long and I’ve no doubt lost names along the way. But my gratitude to: Pat Baumgardner, Helen Blau, Michele Carter, Isabel Davis, Stanely Elkin, John Felstiner, Albert Guerard, Maclin Guerard, Ruthellen Josselson, Herant Katchadourian, Stina Katchadourian, Marguerite Lederberg, John L’Heureux, Morton Lieberman, Dee Lum, K. Y. Lum, Mary Jane Moffatt, Nan Robinson, my sister Jean Rose, Gena Sorensen, David Spiegel, Winfried Weiss, my son Benjamin Yalom, the 1988 class of Stanford residents and psychology interns, my secretary Bea Mitchell who, for ten years, typed the clinical notes and ideas from which these stories spring. As always, I am grateful to Stanford University for providing me with the support, academic freedom, and intellectual community so essential for my work.
I owe a great debt to the ten patients who grace these pages. Each read every line of his or her story (except for one patient who died before I finished) and gave me approval for publication. Each checked and approved the disguise, many offered editorial help, one (Dave) gave me the title of his story, some commented that the disguise was unnecessarily extensive and urged me to be more accurate, a couple were unsettled by my personal self-revelation or by some of the dramatic liberties I took but, nonetheless, in the hope that the tale would be useful to therapists and/or other patients, gave me both their consent and their blessing. To all, my deepest gratitude.
These are true stories, but I have had to make many changes to protect the identity of the patients. I have often made symbolically equivalent substitutes for aspects of a patient’s identity and life circumstances; occasionally I have grafted part of another patient’s identity onto the protagonist. Often dialogue is fictional, and my personal reflections post hoc. The disguise is deep, penetrable in each case only by the patient. Any readers who believe they recognize one of the ten will, I am certain, be mistaken.
PROLOGUE
Imagine this scene: three to four hundred people, strangers to each other, are told to pair up and ask their partner one single question, “What do you want?” over and over and over again.
Could anything be simpler? One innocent question and its answer. And yet, time after time, I have seen this group exercise evoke unexpectedly powerful feelings. Often, within minutes, the room rocks with emotion. Men and women—and these are by no means desperate or needy but successful, well-functioning, well-dressed people who glitter as they walk—are stirred to their depths. They call out to those who are forever lost—dead or absent parents, spouses, children, friends: “I want to see you again.” “I want your love.” “I want to know you’re proud of me.” “I want you to know I love you and how sorry I am I never told you.” “I want you back—I am so lonely.” “I want the childhood I never had.” “I want to be healthy—to be young again. I want to be loved, to be respected. I want my life to mean something. I want to accomplish something. I want to matter, to be important, to be remembered.”
So much wanting. So much longing. And so much pain, so close to the surface, only minutes deep. Destiny pain. Existence pain. Pain that is always there, whirring continuously just beneath the membrane of life. Pain that is all too easily accessible. Many things—a simple group exercise, a few minutes of deep reflection, a work of art, a sermon, a personal crisis, a loss—remind us that our deepest wants can never be fulfilled: our wants for youth, for a halt to aging, for the return of vanished ones, for eternal love, protection, significance, for immortality itself.
It is when these unattainable wants come to dominate our lives that we turn for help to family, to friends, to religion—sometimes to psychotherapists.
In this book I tell the stories of ten patients who turned to therapy, and in the course of their work struggled with existence pain. This was not the reason they came to me for help; on the contrary, all ten were suffering the common problems of everyday life: loneliness, self-contempt, impotence, migraine headaches, sexual compulsivity, obesity, hypertension, grief, a consuming love obsession, mood swings, depression. Yet somehow (a “somehow” that unfolds differently in each story), therapy uncovered deep roots of these everyday problems—roots stretching down to the bedrock of existence.
“I want! I want!” is heard throughout these tales. One patient cried, “I want my dead darling daughter back,” as she neglected her two living sons. Another insisted, “I want to fuck every woman I see,” as his lymphatic cancer invaded the crawl spaces of his body. And another pleaded, “I want the parents, the childhood I never had,” as he agonized over three letters he could not bring himself to open. And another declared, “I want to be young forever,” as she, an old woman, could not relinquish her obsessive love for a man thirty-five years younger.
I believe that the primal stuff of psychotherapy is always such existence pain—and not, as is often claimed, repressed instinctual strivings or imperfectly buried shards of a tragic personal past. In my therapy with each of these ten patients, my primary clinical assumption—an assumption on which I based my technique—is that basic anxiety emerges from a person’s endeavors, conscious and unconscious, to cope with the harsh facts of life, the “givens” of existence.1
I have found that four givens
are particularly relevant to psychotherapy: the inevitability of death for each of us and for those we love; the freedom to make our lives as we will; our ultimate aloneness; and, finally, the absence of any obvious meaning or sense to life. However grim these givens may seem, they contain the seeds of wisdom and redemption. I hope to demonstrate, in these ten tales of psychotherapy, that it is possible to confront the truths of existence and harness their power in the service of personal change and growth.
Of these facts of life, death is the most obvious, most intuitively apparent. At an early age, far earlier than is often thought, we learn that death will come, and that from it there is no escape. Nonetheless, “everything,” in Spinoza’s words, “endeavors to persist in its own being.” At one’s core there is an ever-present conflict between the wish to continue to exist and the awareness of inevitable death.
To adapt to the reality of death, we are endlessly ingenious in devising ways to deny or escape it. When we are young, we deny death with the help of parental reassurances and secular and religious myths; later, we personify it by transforming it into an entity, a monster, a sandman, a demon. After all, if death is some pursuing entity, then one may yet find a way to elude it; besides, frightening as a death-bearing monster may be, it is less frightening than the truth—that one carries within the spores of one’s own death. Later, children experiment with other ways to attenuate death anxiety: they detoxify death by taunting it, challenge it through daredevilry, or desensitize it by exposing themselves, in the reassuring company of peers and warm buttered popcorn, to ghost stories and horror films.
As we grow older, we learn to put death out of mind; we distract ourselves; we transform it into something positive (passing on, going home, rejoining God, peace at last); we deny it with sustaining myths; we strive for immortality through imperishable works, by projecting our seed into the future through our children, or by embracing a religious system that offers spiritual perpetuation.
Many people take issue with this description of death denial. “Nonsense!” they say. “We don’t deny death. Everyone’s going to die. We know that. The facts are obvious. But is there any point to dwelling on it?”
The truth is that we know but do not know. We know about death, intellectually we know the facts, but we—that is, the unconscious portion of the mind that protects us from overwhelming anxiety—have split off, or dissociated, the terror associated with death. This dissociative process is unconscious, invisible to us, but we can be convinced of its existence in those rare episodes when the machinery of denial fails and death anxiety breaks through in full force. That may happen only rarely, sometimes only once or twice in a lifetime. Occasionally it happens during waking life, sometimes after a personal brush with death, or when a loved one has died; but more commonly death anxiety surfaces in nightmares.
A nightmare is a failed dream, a dream that, by not “handling” anxiety, has failed in its role as the guardian of sleep. Though nightmares differ in manifest content, the underlying process of every nightmare is the same: raw death anxiety has escaped its keepers and exploded into consciousness. The story “In Search of the Dreamer” offers a unique backstage view of the escape of death anxiety and the mind’s last-ditch attempt to contain it: here, amidst the pervasive, dark death imagery of Marvin’s nightmare is one life-promoting, death-defying instrument—the glowing white-tipped cane with which the dreamer engages in a sexual duel with death.
The sexual act is seen also by the protagonists of other stories as a talisman to ward off diminishment, aging, and approaching death: thus, the compulsive promiscuity of a young man in the face of his killing cancer (“If Rape Were Legal . . . “); and an old man’s clinging to yellowing thirty-year-old letters from his dead lover (“Do Not Go Gentle”).
In my many years of work with cancer patients facing imminent death, I have noted two particularly powerful and common methods of allaying fears about death, two beliefs, or delusions, that afford a sense of safety. One is the belief in personal specialness; the other, the belief in an ultimate rescuer. While these are delusions in that they represent “fixed false beliefs,” I do not employ the term delusion in a pejorative sense: these are universal beliefs which, at some level of consciousness, exist in all of us and play a role in several of these tales.
Specialness is the belief that one is invulnerable, inviolable—beyond the ordinary laws of human biology and destiny. At some point in life, each of us will face some crisis: it may be serious illness, career failure, or divorce; or as happened to Elva in “I Never Thought It Would Happen to Me,” it may be an event as simple as a purse snatching, which suddenly lays bare one’s ordinariness and challenges the common assumption that life will always be an eternal upward spiral.
While the belief in personal specialness provides a sense of safety from within, the other major mechanism of death denial—belief in an ultimate rescuer—permits us to feel forever watched and protected by an outside force. Though we may falter, grow ill, though we may arrive at the very edge of life, there is, we are convinced, a looming, omnipotent servant who will always bring us back.
Together these two belief systems constitute a dialectic—two diametrically opposed responses to the human situation. The human being either asserts autonomy by heroic self-assertion or seeks safety through fusing with a superior force: that is, one either emerges or merges, separates or embeds. One becomes one’s own parent or remains the eternal child.
Most of us, most of the time, live comfortably by uneasily avoiding the glance of death, by chuckling and agreeing with Woody Allen when he says, “I’m not afraid of death. I just don’t want to be there when it happens.” But there is another way—a long tradition, applicable to psychotherapy—that teaches us that full awareness of death ripens our wisdom and enriches our life. The dying words of one of my patients (in “If Rape Were Legal . . .”) demonstrate that though the fact, the physicality, of death destroys us, the idea of death may save us.
Freedom, another given of existence, presents a dilemma for several of these ten patients. When Betty, an obese patient, announced that she had binged just before coming to see me and was planning to binge again as soon as she left my office, she was attempting to give up her freedom by persuading me to assume control of her. The entire course of therapy of another patient (Thelma in “Love’s Executioner”) revolved around the theme of surrender to a former lover (and therapist) and my search for strategies to help her reclaim her power and freedom.
Freedom as a given seems the very antithesis of death. While we dread death, we generally consider freedom to be unequivocally positive. Has not the history of Western civilization been punctuated with yearnings for freedom, even driven by it? Yet freedom from an existential perspective is bonded to anxiety in asserting that, contrary to everyday experience, we do not enter into, and ultimately leave, a well-structured universe with an eternal grand design. Freedom means that one is responsible for one’s own choices, actions, one’s own life situation.
Though the word responsible may be used in a variety of ways, I prefer Sartre’s definition: to be responsible is to “be the author of,” each of us being thus the author of his or her own life design. We are free to be anything but unfree: we are, Sartre would say, condemned to freedom. Indeed, some philosophers claim much more: that the architecture of the human mind makes each of us even responsible for the structure of external reality, for the very form of space and time. It is here, in the idea of self-construction, where anxiety dwells: we are creatures who desire structure, and we are frightened by a concept of freedom which implies that beneath us there is nothing, sheer groundlessness.
Every therapist knows that the crucial first step in therapy is the patient’s assumption of responsibility for his or her life predicament. As long as one believes that one’s problems are caused by some force or agency outside oneself, there is no leverage in therapy. If, after all, the problem lies out there, then why should one change oneself? It is the outside world (f
riends, job, spouse) that must be changed—or exchanged. Thus, Dave (in “Do Not Go Gentle”), complaining bitterly of being locked in a marital prison by a snoopy, possessive wife-warden, could not proceed in therapy until he recognized how he himself was responsible for the construction of that prison.
Since patients tend to resist assuming responsibility, therapists must develop techniques to make patients aware of how they themselves create their own problems. A powerful technique, which I use in many of these cases, is the here-and-now focus. Since patients tend to re-create in the therapy setting the same interpersonal problems that bedevil them in their lives outside, I focus on what is going on at the moment between a patient and me rather than on the events of his or her past or current life. By examining the details of the therapy relationship (or, in a therapy group, the relationships among the group members), I can point out on the spot how a patient influences the responses of other people. Thus, though Dave could resist assuming responsibility for his marital problems, he could not resist the immediate data he himself was generating in group therapy: that is, his secretive, teasing, and elusive behavior was activating the other group members to respond to him much as his wife did at home.
In similar fashion, Betty’s (“Fat Lady”) therapy was ineffective as long as she could attribute her loneliness to the flaky, rootless California culture. It was only when I demonstrated how, in our hours together, her impersonal, shy, distancing manner re-created the same impersonal environment in therapy, that she could begin to explore her responsibility for creating her own isolation.